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cyclist-LBP question
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cyclist-LBP question - February 4, 2001 1:58:00 PM
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mjb41
Posts: 7
Joined: February 3, 2001
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Patient is an avid mountain biker and has been complaining of left sided lumbothoracic pain that increases with long climbs. His LE's are generally tight, tighter HS on right. He has a slight right rotoscoliosis and increased thoracic kyphosis. No leg length issues. Pelvis is WNL. Spine mobility is WNL and unable to reproduce complaint with any tests. His left paraspinals are significantly more developed than his right. His right LE in uniformly stronger than his left and he admitts that he does favor his right leg while on the bike. He describes the discomfort as a "bad muscle burn" that only eases with stopping the climb. He has two trigger points left quadratus lumborum. He has had a "bike fit" done two months ago and hasn't helped. Soft tissue work helps short term. Abdominal strength is 5/5. Any suggestion????????
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Re: cyclist-LBP question - February 4, 2001 4:31:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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First of all, how is his psoas length? Potential TP's here??
Secondly, when seated on a bike, you are in extreme flexion. Over prolonged periods of time, the patient could be experiencing disc pressure on the dura mater. How long does it take for the pain to go away? What takes the pain away...standing, extension, lying down?
Also, how long has this been occuring? Has the patient changed his routine (increased distance or the amount of hills too much)?
One thing I also ask a patient when there is pain in that region is any kidney/urinary problems. Where the pain is intermittent, I'm sure there is no correlation but you never know!
Lastly, any history of LBP? Pt's age?
Please keep posted....Thanx
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Re: cyclist-LBP question - February 4, 2001 5:20:00 PM
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mcap
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Dear mjb41:
You could certainly make a case for some kind of muscle imbalance going on. Perhaps some of the extensor muscles of the spine have to stabilize the trunk eccentrically into flexion as he bends forward to emphasize the downstroke with the Right LE. But figuring these things out is difficult and there is no real research to support you. Furthermore it may be difficult to find out what structures are being affected by this imbalance.
The point is, you have already found some deficits to work with. I would simply begin to address them. Look at symetry and strength of the paraspinals and the flexibility and strength and symetry of all of the LE muscles.
The segmental stabilization program is never a bad idea. As you are working on these things, see if you can get him to curtail his biking a little. And, see if you can get him to stop favoring his right LE.
And finally, you must respond to that most interesting post on sitting [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
mcap
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Re: cyclist-LBP question - February 4, 2001 5:23:00 PM
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mcap
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Also:
The quadratus lumborum can refer pain - I think. It is possible that the lesion is there but the advice remains the same. Find the deficits and treat them. Why should you have to give him a precise cause of pain when 1. It may not be necessary, and 2. It just isn't possible in most cases.
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Re: cyclist-LBP question - February 4, 2001 7:30:00 PM
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mjb41
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Joined: February 3, 2001
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The patient is 30 y/o. He is just about to start the race season and significant time off the bike is not an option right now. His psoas' are tight bilaterally (equal). Urinary/kidney probs crossed my mind early, but what he describes as a "lactic acid burn feeling" localized to his left paraspinals only happens are climbs. I can't reproduce on the stationary bike in the clinic. One key piece on info that I left out, is that he is on a relatively new bike. It is set up much more aggresively than his previous (much more flexion). That is without a doubt adding to the problem, but I know it's not the cause. As I said before his left paraspinals are so much more developed, as well as RLE. MUSCLE IMBALANCE. I have him doing a comprehensive stretching program(HEP and while riding) as well as drills to work on his left leg efficiency-motor learning-it's difficult to get someone to change their pedal stroke after years of doing it wrong. Any other suggestions are greatly appreciated!!!!!
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Re: cyclist-LBP question - February 5, 2001 1:35:00 AM
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Barrett
Posts: 967
Joined: July 28, 1999
From: Cuyahoga Falls, Ohio
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mcap,
Could you explain how a muscle imbalance causes pain? I have never understood this. Perhaps this is why there isn't any research to support the idea.
Butler's newest book would explain this problem completely, and shortened or weakened muscles have nothing to do with it.
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Re: cyclist-LBP question - February 5, 2001 3:49:00 AM
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mcap
Posts: 652
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Barrett:
Do you read my posts? Where did I say that a muscle imbalance causes pain?
All I said was that there may be a muscle imbalance that altered the mechanics. This may cause pain in one or more structures, ie. muscle, ligament, facet, nerve, etc. I indicated that determining this structure may be impossible. AND.....I also took the time and trouble to indicate that with muscle imbalance you are standing on thin ground research wise.
Once again, you are criticizing musculoskeletal theories that lack research support. You then counter with neurological theory that lacks similar substantiation. You have made your mind up about the source of many MSDs and you view all of the research and theories through that window. You are not objective.
mcap
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Re: cyclist-LBP question - February 5, 2001 7:27:00 AM
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chrishkpt
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Joined: January 29, 2001
From: hong kong SAR
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I agree with mcap that mm imbalance itself is not necessarily causing pain; however, this may cause secondary alteration in biomechanics of the various body part which can predispose to increased faulty stress and strain to tissues and cause damage and hence pain.
I would also suggest that the tight mm can be a sing of overuse with development of trigger point, which can also cause pain.
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Re: cyclist-LBP question - February 5, 2001 7:36:00 AM
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Barrett
Posts: 967
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From: Cuyahoga Falls, Ohio
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Saying that muscular imbalance does not cause pain but only leads directly to mechanical problems that subsequently hurt does not strike me an especially profound distinction. In your opinion, where would the mechanical problem (in the absence of trauma) come from if not from muscular imbalance, which, by the way, has never been shown to produce the mechanical deformation you suppose does cause the pain?
Please pause and read that sentence again in order to understand it. I know I had to, and I actually wrote it.
mcap, Saying there is no evidence that abnormal neurodynamics can produce the pain described is simply not true. Like I said, check out Butler's book. That's why he wrote it.
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Re: cyclist-LBP question - February 5, 2001 1:50:00 PM
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Bobcat
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Getting rid of the bike is a good idea.
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Re: cyclist-LBP question - February 8, 2001 7:14:00 AM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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Can muscle imbalance cause muscle fatigue symptoms ("lactic acid burning feeling") if place under high demand? Why not???
If you place equal demand on the same muscle groups on either side of the body the weaker side will fatigue quicker and produce that "bad muscle burn" feeling. (do arm curls with 20# until failure and document the results)I do understand that muscles do not send pain signals to the brain, nerves do. But the muscles are the source of the symptoms?
(I have Butler's book on order but would like a brief explanation until it arrives.)
As I see this patient- attempt to re-educate the right multifidus and focus on endurance.
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Re: cyclist-LBP question - February 8, 2001 12:53:00 PM
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mcap
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Joined: February 8, 2000
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Barrett:
Think of a shoulder. An imbalance in the muscles of the shoulder can cause impingement. In this case the muscles out of balance need not be the ones that develop tendonitis.
There is growing evidence that female atheletes have quad/hamstring imbalances that may contribute to acl injuries.
To move it to the above mentioned cyclist is a bit more complicated. Here is someone without major deficits. But if muscle function is compromised, it is clear that damage to the joint or other structures can ensue.
When you get post-operative patients, don't you try and restore their muscle balance?
I don't think the theory can be applied in every situation and I realize that the research support can be lacking. But it is more plausible than anything you have suggested.
mcap
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